What is it used for?

• Replacement therapy for people whose adrenal glands do not produce sufficient amounts of natural steroid hormones (adrenal insufficiency), for example in Addison's disease, following surgical removal of the adrenal glands, or in people with an underactive pituitary gland (hypopituitarism).

How does it work?

• Hydrocortisone is a type of medicine known as a corticosteroid. Corticosteroid medicines are derivatives of the corticosteroid hormones cortisol and aldosterone that are produced naturally by the adrenal glands. They are often simply called steroids, but it should be noted that they are very different from another group of steroids, called anabolic steroids, which have gained notoriety because of their abuse by some athletes and body builders.
• Corticosteroids have many important functions on every organ system. They affect the strength of heart muscle and its response to natural chemicals affecting heart rate. They affect the water and salt balance in the body and also enable the body to cope with stress. Stress includes changes in temperature, pain, fear, anxiety and illness. Stress can be hazardous if the body is not equipped to cope due to low levels of corticosteroids. Corticosteroids allow us to respond to stress by increasing the rate and force of the heartbeat, increasing blood supply to essential tissues (muscle, heart, brain), increasing the body's supply of energy by raising blood sugar and by several other effects on body systems.
• If the body's natural level of steroid hormones is too low because the adrenal glands are not producing enough hormones (a condition called adrenal insufficiency, for example in Addison's disease or following surgical removal of the adrenal glands), this can cause various symptoms, such as dizziness, fatigue, weakness, gut symptoms, depression and joint and muscle pain. It can also lead to collapse and death if the body is put under stress. Low blood levels of corticosteroids must be treated with replacement therapy to allow the body to function normally.
• Hydrocortisone is used as replacement therapy. It's action in the body is most similar to the natural steroid hormone cortisol. It is usually given in two daily doses, the larger in the morning and the smaller in the evening, to mimic the natural production of corticosteroids by the body. It is normally used in combination with fludrocortisone tablets for complete replacement therapy. Fludrocortisone is used to replace the natural steroid hormone aldosterone.

Steroid replacement treatment is almost always lifelong.

Important

• Hydrocortisone tablets should be taken after food to minimise irritation to the stomach.
• You should not stop taking this medicine suddenly, particularly if you have been taking more than 30mg daily for longer than three weeks, unless your doctor tells you otherwise. This is because your body becomes dependent on the medicine. If your treatment is to be stopped the dose should be tapered down gradually. Your doctor may also want you to stop treatment gradually if you have been taking high doses (more than 160mg hydrocortisone daily) even if only for three weeks or less; if you have been treated with corticosteroid tablets or injections in the last year; if you had problems with your adrenal glands before treatment was started; or if you have been repeatedly taking doses in the evening.
• You will be given a steroid card with your medicine. The card contains details of your prescriber, type of steroid, dose taken and the duration of treatment. It's purpose is to act as a reminder that your medicine should not be stopped suddenly, and to provide information of your treatment to other people treating you.

Use with caution in

• Children and adolescents.
• Elderly people.
• Decreased kidney function or kidney inflammation.
• Liver failure.
• Liver cirrhosis.
• Active peptic ulcer or history of peptic ulcer.
• Inflammation of the bowel and back passage (ulcerative colitis).
• Painful inflammation of small sacs or pouches in the wall of the gut (diverticulitis).
• People who have recently had a surgical procedure called intestinal anastomosis, which involves the joining together of ends of the intestine after a section has been removed.
• Inflammation of a vein associated with blood clot formation (thrombophlebitis).
• Cancer that has spread from its original site to somewhere else in the body (metastatic carcinoma).
• Heart failure.
• People who have recently had a heart attack.
• High blood pressure (hypertension).
• Diabetes, or a family history of diabetes.
• Underactive thyroid gland (hypothyroidism).
• Epilepsy.
• Glaucoma, or a family history of glaucoma.
• Current severe psychiatric illness, or a personal or family history of psychiatric illness, including depression, manic depression or schizophrenia.
• History of psychiatric illness caused by the use of a corticosteroid.
• Osteoporosis.
• Women who have passed the menopause.
• Abnormal muscle weakness (myasthenia gravis).
• People who have previously experienced muscle disorders (myopathy) caused by steroids.
• People with a history of tuberculosis (TB).
• Herpes simplex virus infection of the eye.
• People with parasitic infections, eg amoebiasis, strongyloidiasis.
• Malaria affecting the brain (cerebral malaria).
• History of allergies to medicines.
• People with a low level of potassium in their blood (hypokalaemia).

Not to be used in

• People with widespread fungal infection, unless this is being treated with specific anti-infectives.
• Rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption (the tablets contain lactose).
• This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

• Women taking this medicine for replacement therapy will need to continue treatment if they become pregnant, as the medicine is essential for the health of the mother. However, the medicine may slow the growth of the baby in the womb. It may also cause the baby to make less of its own steroid hormones after birth, although this usually resolves on its own and rarely causes any problems. The baby may need extra monitoring during the pregnancy and after birth. Women who develop pre-eclampsia or fluid retention during their pregnancy will need also extra monitoring. Women who need continuous treatment with this medicine should seek medical advice from their doctor before planning a pregnancy.
• If you think you could have fallen pregnant while you are taking this medicine you should consult your doctor for advice. It is important that you do not suddenly stop taking the medicine unless your doctor tells you to - see the warnings above.
• Corticosteroids pass into breast milk. You should seek medical advice from your doctor before breastfeeding while taking this medicine. The presence of the corticosteroid in the milk could cause a decrease in the natural production of steroid hormones by the infant's adrenal glands.

Side effects

• Raised blood sugar level.
• Increased appetite and weight gain.
• Increased susceptibility to infections and increased severity of infections (see warnings above).
• Effects on the gut, such as indigestion or abdominal bloating, nausea, ulceration in the stomach or intestine, inflammation of the pancreas (pancreatitis).
• Ulceration or thrush infection in the throat.
• Muscle weakness or wasting.
• Thinning of the bones (osteoporosis) and increased risk of breaking a bone.
• Effects on the skin, such as skin thinning, impaired healing, acne, bruising, stretch marks, increased sweating, change in pigmentation, increased hair growth (hirsutism).
• Psychiatric reactions, such as mood changes (including irritability, depression and suicidal thoughts), psychotic reactions (including mania, delusions and hallucinations), anxiety, confusion, memory loss, sleep disturbances (see warning above).
• Cushing's syndrome, characterised by a moon face.
• Menstrual disturbances.
• Sodium and water retention.
• Increase in blood pressure (hypertension).
• Decrease in the level of potassium in the blood.
• Decrease in the production of natural steroids by the adrenal glands (adrenal suppression - see warning above).
• Effects on the eyes, such as raised pressure inside the eye (glaucoma), cataracts.
• Slowed growth in children and adolescents.
• Raised pressure inside the skull (intracranial pressure).
• Hiccups.
• Blood clots in the blood vessels (thromboembolism).

The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

Hydrocortisone can cause fluid and salt retention and so may oppose the effects of the following medicines:

• antihypertensive medicines used to treat high blood pressure
• diuretics, eg furosemide.
• Hydrocortisone may increase blood sugar levels and so may oppose the blood sugar lowering effects of antidiabetic medicines. People with diabetes may need an increase in their dose of insulin or antidiabetic tablets.

There may be an increased chance of the level of potassium in the blood falling too low (hypokalaemia) if hydrocortisone is used in combination with any of the following medicines, which can also lower the amount of potassium in the blood:

• acetazolamide
• amphotericin
• beta agonists, eg salbutamol, salmeterol, terbutaline
• carbenoxolone
• potassium-losing diuretics, eg furosemide, bendroflumethiazide
• theophylline.

If the level of potassium in your blood falls during treatment, this can increase the risk of side effects on the heart caused by a medicine called digoxin.

Hydrocortisone may enhance the anti-blood-clotting effect of anticoagulant medicines such as warfarin. People taking anticoagulant medicines in combination with hydrocortisone should have their blood clotting time (INR) regularly monitored, particularly after starting or stopping treatment with hydrocortisone and after any dose changes.

If hydrocortisone is used in combination with non-steroidal anti-inflammatory drugs (NSAIDs) eg ibuprofen, there may be an increased risk of side effects on the gut, such as stomach ulceration and bleeding.

Hydrocortisone may decrease the blood levels of salicylates such as aspirin. When hydrocortisone is stopped, this may result in excessive levels of the salicylate, unless the dose is readjusted.

The following medicines may increase the removal of hydrocortisone from the body, thus reducing its effects. You may need a larger dose of hydrocortisone if you are also taking any of these medicines:

• barbituates, eg amobarbital, phenobarbital
• carbamazepine
• phenytoin
• primidone
• rifabutin
• rifampicin.

The effect of corticosteroids may be reduced in the three to four days following use of mifepristone.

The following medicines may reduce the removal of hydrocortisone from the body and so may increase its effects or side effects:

• ciclosporin (hydrocortisone may also increase the blood level and risk of side effects of ciclosporin)
• itraconazole
• ketoconazole
• macrolide-type antibiotics, eg erythromycin
• protease inhibitors such as ritonavir.

Hydrocortisone may decrease the body's immune response. This means that vaccines may be less effective if given during treatment, because the body does not produce sufficient antibodies. Live vaccines may cause serious infections. Live vaccines include: measles, mumps, rubella, MMR, BCG, chickenpox, oral polio, oral typhoid and yellow fever. These should not be given to people whose immune system is underactive due to treatment with this medicine.

References:

http://chemocare.com/chemotherapy/drug-info/hydrocortisone.aspx

https://www.netdoctor.co.uk/medicines/liver-kidney-urinary-system/a6874/hydrocortisone-tablets/

https://www.nhs.uk/medicines/hydrocortisone-tablets/

https://www.healthline.com/health/hydrocortisone-oral-tablet

https://www.webmd.com/drugs/2/drug-6731/hydrocortisone-oral/details

https://patient.info/medicine/hydrocortisone-tablets-for-cortisol-replacement-plenadren